START OF 2018 OPEN ENROLLMENT PERIOD

Time: D H M S

One More Post re. Paid/Unpaid

I just posted a lonnnnnng explanation the details of the "But how many have PAID???" situation. It gets kind of deep into the weeds, so I'll stop now, but I do just want to simplify things with a shorter, separate post:

Let's be clear about this: SOME of the people who haven't paid ARE going to prove to be deadbeats. That's inevitable in any industry that serves millions of people, just as shoplifting is a real problem that retailers have to deal with (and as I noted earlier, what was the insurance industry norm for cancelled/unpaid premiums prior to the ACA? Probably fairly low, but how low? 1%? 2%?).

The problem is that the "But how many have PAID???" attack seems to be based on the premise that ALL of the non-payments are deadbeats (or, alternately, that they're ALL due to exchange technical problems).

Here's the thing, though: There's 5 reasons I can think of why the first premium might not be paid yet:

  1. It's not due yet (again, at least 1/3 of the total exchange QHPs won't start coverage until April or May).
  2. THe insurance company hasn't billed them yet (due to either reason #1 or the company billing system having problems).
  3. They HAVE paid but the insurance company billing system is screwed up/backlogged.
  4. The government exchange screwed up with the data transfer (either policy info or payment info).
  5. The customer really is a deadbeat, or otherwise tries to bail out of their legal agreement after completing the process.

Non-Payments Due to Reasons #1, 2 or 3 should NOT be subtracted from the total enrollment number.

Reason #4 CAN legitimately be criticized from a "Gov't Sux!" POV. I'm not sure whether these should be "subtracted" from the total as long as the customer did their part, but they should certainly be separated out (see Massachusetts' "Limbo Status" number).

Non-payments due to reason #5, however, can be legitimately subtracted from the total after it's clear that they're never gonna pay...which, to me, would be around the end of that month.

So, as I keep saying, as of today (March 21st), we can only eliminate #1 for policy premiums for January or February (and possibly March). If those non-payments are due to #5 (or possibly #4), then yes, subtract them. If they fall under category 1, 2 or 3, then keep them. Around late April we can do the same for the April-start premiums, and the same in late May for May-start premiums.